Association of Periodontitis and Edentulism with Inflammatory Biomarkers

Objectives: To evaluate the association between periodontitis/edentulism and inflammatory biomarkers.

Methods: NHANES is a representative survey of the civilian, non-institutionalized US population. For the present study, log-transformed serum concentrations of high-sensitivity C-reactive protein (CRP, NHANES 1999-2004, subjects 20+ years), fibrinogen (NHANES 1999-2002, 40+ years) and white blood cell count (WBC, NHANES 1999-2004, 20+ years) were analyzed as dependent variables in linear regression models. Mean clinical attachment loss (CAL) of mesiobuccal sites and cumulative probing depth (the sum of maximum probing depths of each present tooth) were used as measures of periodontitis. Separate models were fit for both genders adjusting for age, race/ethnicity, BMI, smoking, alcohol consumption, physical activity, diabetes, poverty/income ratio, female hormone use and disease history of stroke, CHD, CHF, COPD and arthritis.

Results: The association between periodontitis/edentulism and inflammatory biomarkers was dependent on BMI. There was a significant, positive, dose-dependent association between mean attachment loss and inflammatory biomarkers in subjects with BMI<25kg/m² only. For example, men with mean CAL 3+mm had 109% (95% CI: 56%, 180%) higher CRP concentrations, 13% (6%, 21%) higher fibrinogen concentrations and 15% (9%, 22%) higher WBC than men with mean CAL<1 mm. No association was found among overweight or obese subjects. Edentulism was also associated with increased inflammatory biomarkers. Compared to dentate men with mean CAL <1 mm, edentulous men had 130% (86%, 184%) higher CRP, 7% (1%, 13%) higher fibrinogen and 10% (3%, 17%) higher WBC among those with BMI<25.kg/m². No association was present among overweight or obese individuals. Similar results were found for fibrinogen and WBC. Using cumulative probing depth as a measure of periodontitis yielded inconsistent results.

Conclusions: Both history of periodontitis as measured by mean clinical attachment loss and edentulism are associated with increased levels of inflammatory biomarkers in a dose-dependent fashion among normal weight individuals.